残留内翻对弓形股骨患者全膝关节置换术后功能恢复的影响

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摘要目的探究残留内翻的下肢力线对弓形股骨患者行全膝关节置换术(total knee arthroplasty，TKA)术后功能恢复的影响。方法本研究回顾性收集西安市红会医院膝关节外科2015年1月至2015年12月，接受同一术者实施TKA的59例(71膝)骨关节炎患者的全部资料，其中男6例(8膝)，女53例(63膝)；年龄58~82岁，平均(67.7±5.7)岁。测量患者股骨侧弓角(femoral bowing angle，FBA)及下肢力线(hip-knee-ankle angle，HKA)。FBA＜177°定义为弓形股骨。根据术后负重位标准正位X线片将患者分为两组：残留内翻组32例37膝(HKA＜177°)，中立位力线组27例34膝［HKA为(180±3)°］。以美国膝关节协会评分(knee society score，KSS)及西安大略和麦克马斯特大学骨关节炎指数评分(the western Ontario and McMaster universities osteoarthritis index，WOMAC)评价两组术后功能及症状。结果患者均获随访，随访时间43~55个月，平均随访时间为(49.30±4.11)个月。全部患者均未见假体松动、感染等严重并发症。两组患者术前KSS及WOMAC评分比较，差异无统计学意义(P＜0.05)；手术前后比较差异有统计学意义(P＞0.05)；术后残留内翻组WOMAC总分［(5.57±6.23)分］较中立位力线组［(9.27±8.86)分］明显降低，WOMAC C部分(日常生活困难程度)评分［(4.95±5.87)分］显著低于中立位力线组［(8.24±7.68)分］，余各评分比较差异无统计学意义(P＜0.05)。结论相比中立位力线，存在弓形股骨的患者行TKA术后下肢力线残留内翻可以获得更好的临床结局，但中远期疗效有待进一步观察。

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关键词 ：弓形股骨, 下肢力线, 全膝关节置换术

Abstract：Objective To explore the effect of remaining mild varus on postoperative functional recovery after total knee arthroplasty (TKA) in patients with femoral bowing. Methods A retrospective review of aprospectively maintained data base were performed.We retrospectively analyzed 59 patients (71 knees) of undergoing TKA by the same surgeon，including 6 cases (8 knees) of males and 53 cases(63 knees) of females，from January of 2015 to December of 2015.Mean age of patients was (67.7±5.7)(range 58~82).Femoral bowing Angle and hip-knee-ankle Anglewere measured.FBA<177° was defined as the femoral bowing.Patients were divided into two groups according to the postoperative HKA angle from weight-bearing full-leg radiographs：varus malalignment group with 32 patients (37 knees)，HKA<177°；neutral alignment groupwith 27 patients (34 knees)，HKA was (180±3)°.The Knee Society Score (KSS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were compared between preoperative and postoperative.Results Mean of follow-up was (49.30±4.11)months (range，43~55 months).No revisions occurred in any of the groups at midtermfollow-up.There were no statistical difference in preoperative KSS and WOMAC scores.All patients improved between preoperative and post-operative timepoints(P＜0.05).The WOMAC total score of varus malalignment group(5.57±6.23) were significantly lower than that in the neutral alignment group (9.27±8.86)；the WOMACpart C score of varus malalignment group(4.95±5.87)were significantly lower than that in the neutral alignment group(8.24±7.68).There was no significant difference in the remaining scores (P＜0.05).Conclusion For patients with lateral femoral bowing，residual varus alignment leads to better clinical outcomes after TKA than neutral alignment at a mean follow-up of 49.3 months.However，The effect of residual varus alignment on the survivalship of the prosthesis and the long-term outcome needs to be further evaluated.

Key words： femoral bowing alignment of lower limb total knee arthroplasty

通讯作者: 黄小强

作者简介: 张龙(1993－ )，男，研究生在读，西安交通大学医学院附属红会医院膝关节外科，710021。

引用本文:

张龙 1，2，李辉 2，马建兵 2，卿忠 2，潘文杰 2，赵光辉 2，黄小强 2*. 残留内翻对弓形股骨患者全膝关节置换术后功能恢复的影响[J]. 实用骨科杂志, 2020, 26(4): 304-308.
Zhang Long 1，2,Li Hui 2，Ma Jianbing 2，et al. Effect of Remaining Mild Varus on Clinical Outcome after Total Knee Arthroplasty in Patients with Lateral Femoral Bowing. sygkzz, 2020, 26(4): 304-308.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I4/304

［1］Bellemans J，Colyn W，Vandenneucker H，et al.The chitranjan ranawat award：is neutral mechanical alignment normal for all patients?The concept of constitutional varus［J］.Clin Orthop Relat Res，2012，470(1)：45-53.
［2］Mullaji AB，Marawar SV，Mittal V，et al.A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees［J］.J Arthroplasty，2009，24(6)：861-867.
［3］Yau WP，Chiu KY，Tang WM，et al.Coronal bowing of the femur and tibia in Chinese：its incidence and effects on total knee arthroplasty planning［J］.J Orthop Surg(Hong Kong)，2007，15(1)：32-36.
［4］Tang WM，Zhu YH，Chiu KY，et al.Axial alignment of the lower extremity in Chinese adults［J］.J Bone Joint Surg(Am)，2000，82(11)：1603-1608.
［5］Fang DM，Ritter MA，Davis KE.Coronal alignment in total knee arthroplasty［J］.J Arthroplasty，2009，24(6)：39-43.
［6］Insall J，Scott WN，Ranawat CS.The total condylar knee prosthesis.A report of two hundred and twenty cases.［J］.J Bone Joint Surg(Am)，1979，61(2)：173-180.
［7］Abdel MP，Ollivier M，Parratte S，et al.Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement［J］.J Bone Joint Surg(Am)，2018，100(6)：472-478.
［8］吴伟，郭万首，李传东，等.CT三维重建分析不同体位下股骨侧弓对下肢力线测量的影响［J］.中国组织工程研究，2017，21(11)：1764-1769.
［9］甘浩然，程楷，赵文胜，等.膝骨关节炎中骨性力线改变的影像学及临床研究［J］.实用骨科杂志，2019，25(08)：709-712.
［10］Blumenfeld TJ.CORR Insights：Is TKA using patient-specific instruments comparable to conventional TKA?A randomized controlled study of one system［J］.Clin Orthop Relat Res，2013，471(12)：3996-3997.
［11］吴伟，郭万首，程立明，等.股骨侧弓角的个体差异对全膝人工关节置换术后下肢力线的影响［J］.中华医学杂志，2017，97(13)：1006-1010.
［12］Johnson DR，Dennis DA，Kindsfater KA，et al.Evaluation of total knee arthroplasty performed with and without computer navigation：a bilateral total knee arthroplasty study［J］.J Arthroplasty，2013，28(3)：455-458.
［13］Arbab D，Reimann P，Brucker M，et al.Alignment in total knee arthroplasty——A comparison of patient-specific implants with the conventional technique［J］.Knee，2018，25(5)：882-887.
［14］Liow MHL，Xia Z，Wong MK，et al.Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis.A prospective randomised study［J］.J Arthroplasty，2014，29(12)：2373-2377.
［15］Goh GS，Liow MHL，Tay DK，et al.Accelerometer-based and computer-assisted navigation in total knee arthroplasty：a reduction in mechanical axis outliers does not lead to improvement in functional outcomes or quality of life when compared to conventional total knee arthroplasty［J］.J Arthroplasty，2018，33(2)：379-385.
［16］Budhiparama NC，LumbanGaol I，Ifran NN，et al.Does accelerometer-based navigation have any clinical benefit compared with conventional TKA?A systematic review［J］.Clin Orthop Relat Res，2019(477)：2017-2019.
［17］Kang K，Koh Y，Nam JH，et al.Kinematic alignment in cruciate retaining implants improves the biomechanical function in total knee arthroplasty during gait and deep knee bend［J］.J Knee Surg，2020，33(3)：284-293.
［18］Miller EJ，Pagnano MW，Kaufman KR.Tibiofemoral alignment in posterior stabilized total knee arthroplasty：Staticalignment does not predict dynamic tibial plateau loading［J］.J Orthop Res，2014，32(8)：1068-1074.
［19］Blakeney W，Clément J，Desmeules F，et al.Kinematic alignment in total knee arthroplasty better reproduces normal gait than mechanical alignment［J］.Knee Surg Sports Traumatol Arthrosc，2019，27(5)：1410-1417.
［20］Dossett HG，Swartz GJ，Estrada NA，et al.Kinematically versus mechanically aligned total knee arthroplasty［J］.Orthopedics，2012，35(2)：e160-e169.
［21］Magnussen RA，Weppe F，Demey G，et al.Residual varus alignment does not compromise results of TKAs in patients with preoperative varus［J］.Clin Orthop Relat Res，2011，469(12)：3443-3450.
［22］Matziolis G，Adam J，Perka C，et al.Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement［J］.Arch Orthop Trauma Surg，2010，130(12)：1487-1491.
［23］Klatt BA，Goyal N，Austin MS，et al.Custom-fit total knee arthroplasty(Otis Knee) results in malalignment［J］.J Arthroplasty，2008，23(1)：26-29.
［24］Ritter MA，Davis KE，Meding JB，et al.The effect of alignment and BMI on failure of total knee replacement［J］.J Bone Joint Surg(Am)，2011，93(17)：1588-1596.